OBJECTIVES: Glycoprotein IIb/IIIa inhibitors are highly effective inhibitors of platelet aggregation. The MultiStrategy trial showed Tirofiban or Abciximab were similarly efficacious in resolving ST-segment elevation at 90 min post intervention following Acute Myocardial Infarction. As combination therapy to inhibit platelet function and the coagulation cascade to improve cardiovascular outcome is increasingly common in Acute coronary settings, the focus is turning to cost efficient approaches. We undertook a pharmaco-economic analysis of the MultiStrategy study to identify the most cost-efficient therapy. METHODS: Cost-minimization analysis of a randomized controlled trial, where costs are calculated only when between group statistical differences are identified. Direct medical resources (drugs, procedures, investigations, adverse effects and duration of stay) were prospectively collected within the case report form. Drug costs were average wholesale prices obtained from the manufacturer. RESULTS: Drug utilization and major procedural resources between groups was similar; Clopidogrel (p=0.71), Aspirin (p=0.18), Heparin (p=0.14); PCI; stents (p=0.81), guidewires (p=0.45), non serious adverse events (p=0.41), Bleeding (p=0.775), # Days in hospital (p=0.95). Duration of Tirofiban infusion was longer 19.97h vs. 11.44h (p<0.000) whereas, amount of Glycoprotein inhibitor and number of required vials of drug was higher for Abciximab 23,491µg v. 14,328µg (p<0.000) and 2.933 v. 1.707 (p<0.000) respectively. The average calculated cost of Abciximab was higher than Tirfiban 876.93 vs. €348.20 (p<0.000) or €196,787 total cost difference between study arms (n = 361 patients per arm). CONCLUSIONS: All resource variables were similar between arms except for the randomized medication. No resource implications of medication side-effects or treatment duration were seen. Tirofiban is the more cost-efficient Glycoprotein IIb/IIIa inhibitor in achieving ST-segment resolution at 90min post intervention.